ACTIVITY AND EXERCISE

QUICK REVIEW
1. Defines as : All the ways in which the body moves and methods of using the body to increase efficiency
and reduce strain. Coordinated by efforts of musculoskeletal and nervous sytems

An Activity –Exercise Pattern refers to a person's routine of exercise, activity, leisure, and recreation. It
includes:

Activities of daily living (ADL) that require energy expenditure such as hygiene, cooking , shopping, eating
, working.
Type, quality, and quantity of exercises, including sports.

MOBILITY
The ability to move freely, easily, rhythmically, and purposefully in the environment
Vital to independence
A fully immobilized person is as vulnerable and dependent as an infant
People often define health and physical fitness by their activity because mental well-being and the
effectiveness of body functioning defend largely on their mobility status.
NORMAL MOVEMENT
Normal movement and stability are the result of an intact musculoskeletal system, an intact nervous
system, and intact inner ear structures responsible for equilibrium
Involves four basic elements:
Body alignment(posture), joint mobility, balance, and coordinate movement

ALIGNMENT AND POSTURE

A person maintains balance as long as the LINE OF GRAVITY- an imaginary vertical line drawn through
the body’s center of gravity passes through the CENTER OF GRAVITY- the point at which all the body’s
mass is centered and the BASE OF SUPPORT- the foundation on which the body rests

JOINT MOBILITY

JOINTS- functional units of the musculoskeletal system

MUSCLES- flexors, extensors, internal rotators, and the like
Flexor muscles are stronger than the extensor muscles
ROM(range of motion)- of a joint is the maximum movement that is possible for that joint
BALANCE

PROPRIOCEPTION- the term used to describe awareness of posture, movement, and changes in
equilibrium and the knowledge of position, weight, and resistance of objects in relation to the body

COORDINATE MOVEMENT
Balance, smooth, purposeful movement is the result of proper functioning of the cerebral cortex,
cerebellum, and basal ganglia.

Ligaments; tough fibrous bands that bind joints together & connect bones & cartilages.

Tendon; strong, flexible, inelastic fibrous band that attach muscle to bone.

Cartilage; nonvascular connective tissue found in the joint s as well as in the nose, ear, thorax, trachea
and larynx
PHYSIOLOGY OF MOVEMENT
The following physiology of movement is:
 Skeletal system; the bones and cartilage that protect our organ and allow us to move are called skeletal
system. The function of this system include:

Maintain body posture by supporting the soft tissue

Protect the delicate structures of the body such as brain, heart and spinal cord
Furnishes surface for attachments of muscles tendons and ligaments
Storage areas of minerals salts and fats.
Produce blood cells 
Muscular system; provide functions for the body through
contraction
Motion
Maintenance of posture
Heat production

The 3 types of muscles are 1) Skeletal 2) Cardiac 3) Smooth or visceral muscles.

Muscles have two different points of attachments:
The attachment of a muscle to the more stationary bone is called the Point of Origin.
The attachment to the more movable bone is the Point of Insertion
 

Nervous System; the nerve impulses stimulate muscles to contract.

Body Mechanics; is the efficient use of the body as a machine and as a mean of locomotion, correct
body mechanics lead to health promotion and illness prevention so the responsibility of the nurse to apply
the body mechanics and to teach others .
 

TYPES OF JOINT MOVEMENT

Flexion: decreases the angle of the joint" bending the elbow"

Extension: Increasing the angle of the joint " straightening the arm at the elbow"
Hyperextension: further extension or straightening of a joint " bending the head backward"
Abduction: movement of the bone away from the midline of the body
Adduction: movement of the bone toward the midline of the body
Rotation: movement of the bone around its central axis

Joint Movements

Circumduction: movement of the distal part of the bone in a circle while the proximal end remains fixed.
Eversion: Turning the sole of the foot outward by moving the ankle joint
Inversion: Turning the sole of the foot inward by moving the ankle joint.
Pronation: moving the bones of the forearm so that the palm of the hand faces downward when held in
front of the body.
Supination: moving the bones of the forearm so that the palm of the hand faces upward when held in
front of the body.

PHYSICAL ACTIVITY
is bodily movement produced by skeletal muscle contraction that increases energy expenditure
Exercise
Is a type of physical activity defined as a planned, structured, and repetitive bodily movement performed
to improve or maintain one or more components of physical fitness.
Types of exercise:
Exercise can be classified according to the type of muscle contraction to:-
 Isotonic exercise; in which the muscle shortens to produce muscle contraction and active
movement.Example; running, swimming, walking. This increase muscle mass, tone and strength,
increase cardiac and respiratory and circulatory functions.
Isometric exercise; in which there is muscle contraction without moving the joint shortening. An example
includes squeezing a towel or pillow between the knees. These exercises are useful for
strengthening abdominal, quadriceps and gluteal muscles so the nurse encourage both isotonic
and isometric exercises for the hospitalized client’s.

Isokinetic exercises; involve muscle contraction with resistance example include rehabilitation
exercises for the knee and elbow injuries.
OR exercise can be classified according to the source of energy to:-
Aerobic exercise is activity during which the amount of oxygen taken in the body is greater than that
used to perform the activity. An example walking, running.
Anaerobic exercise involves activity in which the muscles cannot draw out enough oxygen from the
bloodstream, and anaerobic pathways are used to provide additional energy for a short time. An example
weight lifting.

BENEFITS OF EXERCISE
In general, regular exercise is essential for maintaining mental and physical health
MUSCOSKELETAL SYSTEM
With strenuous exercise, muscles hypertrophy (enlarge), and the efficiency of muscular contraction
increases
Exercise increases joint flexibility, stability, and range of motion
Exercise reduce weakness, frailty, depression, and the risk and incidence

CARDIOVASCULAR SYSTEM
Adequate moderate-intensity exercise increases the heart rate, the strength of heart muscle contraction,
and the blood supply to the heart and muscles through increased cardiac output
Promotes heart health by mediating the harmful effects of stress
RESPIRATORY SYSTEM

More toxins are eliminated with deeper breathing and problem solving and emotional stability are
enhance due to increased oxygen to the brain
Prevents pooling of secretions in the bronchi and bronchioles, decreasing breathing effort and risk of
infection

GASTROINTESTINAL SYSTEM
Exercise improves the appetite and increases gastrointestinal tract tone, facilitating peristalsis
Activities such as rowing, swimming, walking, and sit-ups work the abdominal muscles and can help
relieve constipation
Abdominal compressive exercise, such as with twisting, and forward bending yoga postures, has been
shown to improve symptoms of irritable bowel syndrome

METABOLIC/ENDOCRINE SYSTEM
Exercise elevates the metabolic rate, thus increasing the production of body heat and waste products and
calorie use
Increases the use of triglycerides and fatty acids, resulting in a reduced level of serum triglycerides and
make cells more responsive to insulin
URINARY SYSTEM
Promotes efficient blood flow, the body excretes wastes more effectively.
In addition, stasis (stagnation) of urine in the bladder is usually prevented

IMMUNE SYSTEM
Lymph fluid is more efficiently pumped from tissues into lymph capillaries and vessels throughout the
body

PSYCHONEUROLOGIC SYSTEM
A strong and growing body of evidence supports the role of exercise in elevating mood and relieving
stress and anxiety across the life span
Also improves quality of sleep for most individuals
RR (relaxation response), exercise is beneficial for counteracting some of the harmful effects of stress on
the body and mind

COGNITIVE FUNCTION
Physical exertion induces cells in the brain to strengthen and build neuronal connections
Athletic older adults have denser brains than their inactive counterparts.
Brain gym is a series of easy, mostly cross-lateral movements that enhance right-and-left-brain
integration thus improving mood, learning, problem solving, and performance in persons of all ages

BRAIN GYM
BELLY BREATHING:
Place your hands on your abdomen.
Exhale through your mouth in short little puffs, as if you are keeping a feather in the air, until your lungs
feel empty.

Now inhale deeply, filling yourself like a balloon beneath your hand. (By arching your back slightly you
can take in even more air.)
Then slowly and fully exhale. Repeat this inhalation and exhalation, establishing a natural rhythm, during
the course of three or more breaths.

BRAIN BUTTONS:
Rest one hand over your navel.
With the thumb and fingers of the other hand, feel for the two hollow areas under the collarbone, about
one inch out from the centre of the chest. Rub these areas vigorously for 30 seconds to one minutes, as
you look from left to right.

** This stimulates the carotid arteries which supply freshly oxygenated blood to the brain. They help re-
establish directional messages from parts of the body to the brain, improving reading, writing, speaking
and the ability to follow directions.

CROSS-CRAWL:
Standing up, “march” in place, alternately touching each hand to the opposite knee.
Continue during the course of four to eight complete, relaxed breaths.
** This exercise is wonderful for improving reading, listening, writing and memory. It co-ordinates the
whole brain.

SPIRITUAL HEALTH
Exercise significantly enhanced students’ experiences of mind-body spirit connection and relationship
with God
Recitation of a word or phrase (mantra) and rosary prayer were found to powerfully enhance and
synchronize cardiovascular rhythms because of the resulting decrease in respiratory rate
FACTORS AFFECTING BODY ALIGNMENT AND ACTIVITY
Growth and development;
the nurse should be familiar with the differences of the neuromuscular development of the client in order
to facilitate coping.
Physical health; because any problems in the musculoskeletal or nervous system can have negative
influence on the body alignments and movement.
Mental health; bodily processes tend to slow down in depression
Lifestyle variables; such as exercise, food, smoking, occupation, culture.
Attitude and values; such as swim, fitness, many individual values also influence the exercise options
people make.

Fatigue and stress; chronic stress may deplete body energy to the point that fatigue makes even the
thought of exercise overwhelming
External factors; environment which influence, humidity, support people, lack of free time, unsafe
environment.
Nutrition; both undernutritioin and overnutrition can influence body alignment and mobility.
 
Effects of exercise on major body system
Musculoskeletal system
Increased muscle efficiency' strength and flexibility
Increased coordination, stability, gait and posture
Increased efficiency of nerve impulses transmission
Improve range of motion
Maintained bone density and strength

Cardiovascular system;
Meet the demands for oxygen
Increase blood flow
Increase efficiency of the heart
Decreased blood pressure
Increased blood flow to all body parts
Improved heart rate, improved circulation, and self – reported stress
reduction
Decreased cholesterol level

Respiratory system; work together with the cardiovascular system

Increase oxygen available to the muscle
Increase depth, rate of gas exchange, rate of CO2 excretion
Improved pulmonary functioning
Decreasing breathing effort and risk of infection.

GI system; exercises lead to

Increased intestinal tone, facilitating peristalsis
Improve digestion and elimination
Improve the appetite

Metabolic system; exercise elevates the metabolic rate, thus increasing the
production of body heat and waste products and calorie use.
Increased efficiency of metabolic system
Increased efficiency of body temperature regulation
Reduce level of serum triglycerides and cholesterol.
 Urinary system; regular exercise increase blood circulation including improved
blood flow to the kidneys which allows the kidneys to maintain the body's fluid
balance and acid-base balance more efficiently and to excrete body waste.
 

Skin; regular exercise increase circulation which lead to promote good health

Psychosocial outlook; regular exercise have psychological effects such as

increase energy, improve sleep, body image, improve self-concepts and increase
positive health behaviors, improve general well being.
 

EFFECTS OF IMMOBILITY ON MAJOR BODY SYSTEM

Musculoskeletal system
Disuse osteoporosis; demineralization process, known as osteoporosis, the bones become spongy and
may gradually deform and fracture easily.
Disuse atrophy; atrophy in muscles losing most of their strength and normal function.
Contractures; when the muscle fibers are not able to shorten and lengthen (permanent shortening of the
muscle) forms limiting joint mobility. This process eventually involves the tendons, ligaments, and joint
capsules.

Cardiovascular system
Diminished cardiac reserve
Orthostatic hypotension; is a common result of immobilization. The blood pools in the lower extremities,
and central blood pressure drops. Cerebral perfusion is seriously compromised, and the person feels
dizzy or light headed and may even faint.
Venous vasodilation and stasis; the skeletal muscles do not contract sufficiently, and the muscles
atrophy, so the skeletal muscles can no longer assist in pumping blood back to the heart against gravity.
Blood pools in the leg veins, causing vasodilation and engorgement.

Dependent edema; when the venous pressure is sufficiently great, some of serous part of the blood is
forced out of the blood vessel into the interstitial spaces surrounding the blood vessel, causing edema.
Thrombus formation

3. Respiratory system
Decreased respiratory movement; in immobile client, ventilation of the lungs is passively altered. The
body presses against the rigid bed and curtails chest movement. The abdominal organs push against the
diaphragm, restricting lung movement and making it difficult to expand the lungs fully.

Pooling of respiratory secretions; secretions of the respiratory tract are normally expelled by changing
positions or posture and by coughing. Inactivity allows secretions to pool by gravity, interfering with the
normal diffusion of oxygen and carbon dioxide in the alveoli.

Atelectasis; is the collapse of a lobe or of an entire lung, when ventilation is decreased, pooled secretions
may accumulate in a dependent area of a bronchiole and effectively block it. Immobile elderly,
postoperative clients are at greatest risk of Atelectasis.

Pneumonia; pooled secretions provide excellent media for bacterial growth. Under these conditions, a
minor upper respiratory infection can evolve rapidly into severe infection of the lower respiratory tract.

Metabolic system
Decreased metabolic rate; in immobile clients, the basal metabolic rate and gastrointestinal motility and
secretions of various digestive glands decrease as the energy requirements of the body decrease.
Negative nitrogen balance
Anorexia; loss of appetite occurs because of the decreased metabolic rate and the increased catabolism
that accompany immobility.Negative calcium balance
Urinary system

Urinary stasis; in a mobile person, gravity plays an important role in the emptying of the kidneys and the
bladder. When the person remains in abed, gravity impedes the emptying of urine from the kidneys and
the urinary bladder, so emptying is not as complete and urinary stasis occurs after few days of bed rest.

Urinary retention, which is accumulation of urine in the bladder, bladder distention, and occasionally
urinary incontinence (involuntary urination). The decreased muscle tone of the urinary bladder inhibits its
ability to empty completely.
Urinary infection, static urine provides an excellent medium for bacterial growth

Gastrointestinal system
Constipation is a frequent problem for immobilized people because of decreased peristalsis and colon
motility.

Integumentary system
Reduced skin turgor. Skin turgor is an abnormality in the skin's ability to change shape and return to
normal (elasticity).
The skin can atrophy as a result of prolonged immobility.
Skin breakdown. Normal blood circulation relies on muscle activity. Immobility impedes circulation and
diminishes the supply of nutrients to specific areas. As a result skin breakdown and formation of pressure
ulcers can occur.

Psychoneurologic system
Lower the person’s self –esteem
Increased risk of depression
Decreased social interaction

Nursing management
 Assessing
 Nursing History
 Physical examination
Body Alignment
Appearance and movement of joints
Capabilities and limitation for movement
Muscle mass and strength
Activity tolerance
Problems related to immobility

Nursing Diagnosis
Nursing diagnoses related to mobility focus primarily on activity and mobility levels, and the psychosocial
impact that alterations in mobility can have on a client and the
client’s family. Common NANDA nursing diagnoses related to the physical adaptations or risks resulting
from altered mobility include:

• Activity Intolerance related to bed rest and immobility, generalized weakness, sedentary lifestyle, and
imbalance between oxygen supply and demand.
• Impaired Physical Mobility related to intolerance to activity or decreased strength and endurance, pain,
perceptual or cognitive impairment, neuromuscular impairment, musculoskeletal impairment, and
depression or severe anxiety.

• Self-Care Deficits related to inability to wash body or body parts, inability to obtain or get to water
source, activity intolerance, decreased strength and endurance, pain, and impaired transfer ability
• Ineffective Health Maintenance related to lack of or significant alteration in communication skills (written,
nonverbal)

• Risk for Fallsrelated to impaired mobility. Alterations in family and social processes may also result from
immobility and inactivity. Disruption in activity and mobility leads to impairment of the ability to perform
one’s usual social, vocational, educational, and family roles.

There are often changes in the client’s perception of role. DisturbedBody Image and Situational Low Self-
Esteem can result from:
1. Changes in physical abilities
2. Changes in family responsibilities
3. Lack of knowledge regarding rehabilitation
 Fear (of falling)
Ineffective coping
Low self esteem
Powerlessness
 
Planning
Implementing
Nursing strategies to maintain or promote body alignment and mobility involve positioning clients
appropriately, moving and turning clients in bed, transferring clients, providing ROM exercises,
ambulating clients with or without mechanical aids.
 

Techniques to prevent back stress:

Develop a habit of erect posture correct alignment
Use the longest and strongest muscle of the arms and the legs to help provide the power needed in
strenuous activities
Use the internal girdle and a long midriff to stabilize the pelvis and to protect the abdominal viscera when
stopping, reaching , lifting or pulling

Use the weight of the body as a force for pulling or pushing by rocking on the feet or leaning forward or
backward
Work as closely as possible to an object that is to be lifted or moved.
Flex the knees, put on the internal girdle and come down to an object that is to be lifted.
Spread the feet apart to provide a wider base of support when increased stability of body

PROVIDING ROM EXERCISE

ACTIVE ROM EXERCISES- are isotonic exercises in which the client moves each joint in the body
through its complete range of movement, maximally stretching all muscle groups within each plane over
the joint
Maintain or increase muscle strength and endurance and help to maintain cardiorespiratory function in an
immobilized client
PROVIDING ROM EXERCISE
PASSIVE ROM EXERCISES – are of no value in maintaining muscle strength but are useful in
maintaining muscle joint flexibility
Should be accomplish to the point of slight resistance, but not beyond and never to the point of discomfort
Most effectively when the client lies supine in bed

AMBULATING CLIENTS
AMBULATION- the act of walking
Is a function that most people take for granted. However, when are ill they are often confined to bed and
are thus nonambulatory.
The longer clients are in bed, the more difficulty they have in walking.
PRE-AMBULATORY EXERCISE
Clients who have been in bed for long periods often need a plan of muscle tone exercises to strengthen
the muscles used for walking before attempting to walk.
USING MECHANICAL AIDS FOR WALKING

1. CANES- tungkod

2. WALKERS- mechanical devices for ambulatory clients who need more support than a cane providers

3. CRUTCHES-
a. axillary
b. lofstrang
c. platform